Need advice

[peet64]

I am a 55 year old guy. I have had symptoms of hypogonadism since 2016. I would always feel tired, weak erections and hardly any nocturnal erections. I discussed this with my primary physician and he referred me to a urologist. I was able to see the urologist at the beginning of 2017. He did a complete blood panel including testosterone and thyroid. My testosterone results were (total testosterone 349.9, bio avail testosterone 175.8, SHBG. 31, free testosterone 70.27, LH 7.7, FSH 3.1, prolactin 20.3, Estradiol 24.62) I was told it was within the normal range. I was 53 at that time. Anyway the urologist decided to put me on clomid 25mg and cialis 5mg daily.
Within 2 months I started to feel better. Had another blood test and this time my results were: ( total testosterone 783.8, LH 9.3, Estradiol 66.86, SHBG 46, prolactin 7.8, FSH 8.5 ). The tired feeling was gone, nocturnal and spontaneous erections had returned.
In July 2018 my results were ( total testosterone 776.3, bio avail.testosterone 303,free testosterone calculated 11.64, Estradiol64.3, SHBG 57.55,LH 9.2, FSH 8.6, prolactin 11.3).
I questioned about my high estradiol levels and asked if I should be given estrogen blockers. I was told not to worry as long as I don’t have gynomastia or nipple tenderness, I don’t need a blocker. Then in September last year I noticed a decline. Even though I still get lots of nocturnal erections I now observe that spontaneous erections are gone. My erections are not that firm and I can’t maintain erections for long. In addition I sometimes feel depressed and I find I have become more emotional than I use to be.
My plight is, should I go back to my urologist or should I try a testosterone replacement clinic?

 

[YBWV]

I am a 55 year old guy. I have had symptoms of hypogonadism since 2016. I would always feel tired, weak erections and hardly any nocturnal erections. I discussed this with my primary physician and he referred me to a urologist. I was able to see the urologist at the beginning of 2017. He did a complete blood panel including testosterone and thyroid. My testosterone results were (total testosterone 349.9, bio avail testosterone 175.8, SHBG. 31, free testosterone 70.27, LH 7.7, FSH 3.1, prolactin 20.3, Estradiol 24.62) I was told it was within the normal range. I was 53 at that time. Anyway the urologist decided to put me on clomid 25mg and cialis 5mg daily.
Within 2 months I started to feel better. Had another blood test and this time my results were: ( total testosterone 783.8, LH 9.3, Estradiol 66.86, SHBG 46, prolactin 7.8, FSH 8.5 ). The tired feeling was gone, nocturnal and spontaneous erections had returned.
In July 2018 my results were ( total testosterone 776.3, bio avail.testosterone 303,free testosterone calculated 11.64, Estradiol64.3, SHBG 57.55,LH 9.2, FSH 8.6, prolactin 11.3).
I questioned about my high estradiol levels and asked if I should be given estrogen blockers. I was told not to worry as long as I don’t have gynomastia or nipple tenderness, I don’t need a blocker. Then in September last year I noticed a decline. Even though I still get lots of nocturnal erections I now observe that spontaneous erections are gone. My erections are not that firm and I can’t maintain erections for long. In addition I sometimes feel depressed and I find I have become more emotional than I use to be.
My plight is, should I go back to my urologist or should I try a testosterone replacement clinic?

In your shoes I would look to a change in healthcare provider and further I would consult with Dr Saya and his team at Defy medical.
Your Urologist made a good call in trying Clomid. You had a robust response - a doubling of TT - and temporary relief of symptoms.
It's possible that you would have had a better long-term outcome at a lower dose of the Clomid.

If you read the Clomid sub-Forum you will see that the side effects you report now - loss of erecile function, low mood state and heightened emotionality - are all typical of Clomid use and are usually attributed to too high E2 and the effects of the Zuclomiphene isomer in the Clmid

Defy would be well placed to determine if there is any further mileage in Clomid therapy or if you would be better to commence TRT.

 

[Vince]

First make sure you get the right sensitivity estrogen test for men LC-MS/MS. Most men do not do that good on clomid. I still think you should try a lower dose, 12.5 mg every other day. That's the normal protocol for clomid.

 

[Systemlord]

Those Total T and Free T levels are normal, for an elderly man in his 80's. You are at high risk for cardiovascular disease at these levels.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

The denial of healthcare coverage by insurance companies is based on the requirements to meet specific testosterone threshold (under 300 ng/dL), representing a transparent desire on the part of the insurance companies to deny treatment and thereby reduce costs.

This is why you were denied treatment, because according to your insurance company, you don't quality for treatment and it's all so they can cut costs.

Attempting to restore a 55 year old endocrine system using clomid is out of the ordinary, a younger man is another story. Clomid is used for a short duration to jumpstart your natural production is often fails to work.

Be careful of these Low T clinics popping up everywhere, often they are bad news. Often endocrinologists and urologists are no better, you need to look at anti-aging clinics and sports medicine where TRT has existed for decades in preventive medicine.

 

[Vince Carter]

Clomid is usually overdosed, 25mg/D is an overdose, as Vince noted 12.5mg EOD is more likely to have a better outcome. As shown in your labs it pushes SHBG up as well as Estrogen...both are shown clearly in your labs as the outcome of a Clomid overdose.

Both of those will be detrimental to erections. Though note over nite and spontaneous while they seem nice are poor indicators of your sexual health. Though I do note you said tougher to maintain and quality is down for you.

An E2 of 62 even on the correct test would be by most standards too high.

 

[peet64]

Thank you for your input guys, I am going to contact Defy medical.